MEDICARE: TEKEISHA GOGGINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4090C	AL

General Provider Information

NPI Number	:	1891200903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEKEISHA GOGGINS

Provider Business Mailing Address
First Line	:	105 CHURCH ST
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 CHURCH ST
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6242
Country	:	US
Telephone Number	:	256-452-4058
Fax Number	:	256-782-0054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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Directions to “ TEKEISHA GOGGINS ” Practice Location

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